What Medicare deductibles are and how they work

A deductible is the amount you pay out of your own pocket before Medicare starts to pay its share. Medicare Part A (hospital insurance) and Part B (medical insurance) each have their own deductible amounts, and they reset every calendar year on January 1st. The deductible amounts change each year — Medicare announces the new figures in the fall before they take effect.

How it works in practice: if your Part B deductible is $240 and you see your doctor, you pay the first $240 of your covered services yourself. Once you have paid that $240, Medicare begins to cover its portion of your bills. The deductible applies only to covered services — things Medicare does not cover at all do not count toward it.

Key Takeaways

  • Part A and Part B each have separate deductibles that reset every January 1st, and the amounts change yearly.
  • Once you meet your deductible, you still pay coinsurance or copayments for most services — the deductible is not your only out-of-pocket cost.
  • Part D (prescription drug coverage) has its own deductible, which varies by plan and can range from zero to several hundred dollars.
  • Medigap and Medicare Advantage plans change how deductibles work, so your actual costs depend on which plan you chose.

Part A deductible for hospital stays

Part A covers inpatient hospital care, skilled nursing facility care, hospice, and home health services. The Part A deductible applies per benefit period, not per year. A benefit period begins the day you enter the hospital and ends 60 days after you leave — if you go back to the hospital more than 60 days later, a new benefit period starts and you owe a new deductible.

The Part A deductible covers your first day in the hospital. After you meet it, you pay a daily coinsurance amount for days 2 through 60 of your hospital stay, a higher daily amount for days 61 through 90, and even more per day if you stay longer than 90 days. These daily amounts are separate from the deductible and change each year along with it.

Part B deductible for doctor visits and outpatient care

Part B covers doctor visits, outpatient surgery, diagnostic tests, durable medical equipment, and other services and supplies. You pay the Part B deductible once per calendar year. After you meet it, you typically pay 20 percent coinsurance for most Part B services, while Medicare pays 80 percent.

The deductible applies to all Part B covered services combined — you do not have a separate deductible for each type of service. Once you have paid the deductible amount in January through December, you do not owe another deductible until the next calendar year begins.

Part D prescription drug deductible

If you have Part D coverage through a standalone plan or a Medicare Advantage plan that includes drug coverage, that plan has its own deductible. Part D deductibles vary by plan — some plans have no deductible at all, while others may have a deductible of several hundred dollars. You can see the deductible amount for each plan during the annual enrollment period when you compare your options.

After you meet your Part D deductible, you enter a coverage phase where you pay a copayment or coinsurance for each prescription. The copayment amounts also vary by plan and by drug tier (generic, brand-name, specialty, and so on).

How Medigap and Medicare Advantage change your deductible costs

If you have a Medigap (supplemental insurance) plan, that plan pays some or all of your Medicare deductibles and coinsurance, depending on which Medigap plan you chose. Some Medigap plans cover the full Part B deductible, while others cover only part of it. Medigap plans are standardized, so Plan G from one insurer covers the same benefits as Plan G from another — the price differs, but the coverage does not.

If you have a Medicare Advantage plan instead of Original Medicare, the plan sets its own deductible amounts, which may be lower, higher, or the same as Original Medicare. Some Medicare Advantage plans have no deductible at all for certain services. You need to check your specific plan's documents to know what you owe.

Out-of-pocket costs beyond the deductible

Meeting your deductible does not mean Medicare covers everything after that. You still pay coinsurance (a percentage of the cost) or copayments (a fixed dollar amount per visit or service) for most covered services. For example, after you meet your Part B deductible, you pay 20 percent of the approved amount for most services, and Medicare pays 80 percent.

Original Medicare also has an out-of-pocket maximum for Part A and Part B combined. Once you have paid a certain total amount in deductibles, coinsurance, and copayments in a calendar year, Medicare covers 100 percent of your covered services for the rest of that year. The out-of-pocket maximum amount changes each year. Medicare Advantage plans also have out-of-pocket maximums, often lower than Original Medicare, but the details vary by plan.

Where to find the current deductible amounts

Medicare publishes the current year's deductible and coinsurance amounts on Medicare.gov. You can also call 1-800-MEDICARE to speak with someone who can tell you the amounts for the current year and explain how they explore to your situation.

If you have a Medigap or Medicare Advantage plan, your plan documents and your plan's customer service line will show you exactly what you owe. Your plan may have different deductibles or may cover deductibles entirely, so it is worth checking your plan's summary of benefits rather than assuming it matches Original Medicare.

Frequently Asked Questions

Do I have to pay my deductible every year?

Yes. Part A and Part B deductibles reset on January 1st each year. If you have Part D coverage, that deductible also resets annually. The amounts may change from year to year, so the deductible you paid in 2024 may not be the same as 2025.

What happens if I do not meet my deductible by the end of the year?

The deductible does not carry over. If you have not paid your full deductible by December 31st, it resets to zero on January 1st, and you start over. Any amount you paid toward the previous year's deductible does not count toward the new year.

Does my Medigap plan cover the deductible?

It depends on which Medigap plan you have. Some plans cover the full Part B deductible, some cover part of it, and some cover none of it. Your Medigap plan documents will list exactly which deductibles and coinsurance amounts your plan pays. You can also call your Medigap insurer to ask.

Can I use my Health Savings Account to pay my Medicare deductible?

Once you enroll in Medicare, you can no longer contribute to a Health Savings Account. However, you can withdraw money from an HSA you already have to pay Medicare premiums, deductibles, and coinsurance. You cannot use HSA funds to pay for services Medicare does not cover.

What is the difference between a deductible and coinsurance?

A deductible is a set amount you pay before Medicare starts paying. Coinsurance is a percentage of the cost you pay after you meet the deductible — for example, 20 percent. You pay coinsurance on top of your deductible, not instead of it.